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How patient access is being mangled by edict

Most of us would agree the Government's exhortation for 48-hour access, regardless of the nature of the patient's problem and its urgency, has a populist ring about it. It almost certainly arises from the ramblings of focus groups – it ignores the quality and resource implications, and is not rooted in experience.

I have no way of knowing whether the implementation of 48-hour access has been devolved to the PCOs, or whether they have covertly been set targets for its implementation. It is certainly yet another item that can be measured and achieve points in the new contract but, as someone said, in general practice much of what is measured is not important, and much of what is important cannot be measured.

The capacity to deal with a potentially unlimited patient-led demand has to be balanced with the need to give adequate time for each patient because the evidence suggests the most important factor in patients' satisfaction with their care is having unhurried consultation time with the doctor, to be listened to and to be taken seriously. Some practices claim to have achieved this balance – but at what cost in terms of quality of consultations, stress to doctors and staff?

We all hear horror stories about patients waiting two weeks to be seen by their GP that seem to inform the decisions of those who know nothing about general practice. These extreme claims can often be explained by the fact some patients insist on being seen on a particular day of the week, a precise time of the day, and with a particular doctor, or who are arranging appointments for their annual blood pressure check, repeat prescription review, or a medical examination for insurance purposes. Qualitative analysis of this problem is in short supply.

There is a vast difference between importance and urgency. I do not expect all patients to appreciate this. Nor do I expect PCO staff who ring up at intervals to make bogus appointments in order to check our own access performance to appreciate it either. But I do expect doctors to be allowed to exercise their professional judgment on whether all patients need to be seen within 48 hours irrespective of the nature of the problem (or whether your partner is off sick and you can't get a locum), otherwise the line between meeting patients' needs and organisational chaos is likely to be mangled by edict.

Dr Rod Manton

Marple, Cheshire

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